2019 OPEN ENROLLMENT ENDS (most states)

When I last checked in on New Mexico's Medicaid expansion program, they were at around 55% of the total eligible. As of late August (judging by the Sept. 1st byline on the article), that number was up to 71%:

New Mexico projected that Medicaid expansion would sign up 219,000 new enrollees over a six-year period. In the first year alone (2014), they have already signed up 155,000, 71% of the best-case six-year estimate.

According to this article, WV's uninsured rate in 2013 stood at rougly 255K, of which 150K were eligible for the ACA's Medicaid expansion provision. Apparently they hit 145K as of 2 weeks ago...or 97% of the total eligible.

Now, the way the article words it, it's conceivable that the 145K figure could include some renewals and/or "woodworkers", which would mean that the actual percent of newly eligible WV residents is somewhat lower.

However, according to the Kaiser Family Foundation estimates, as of last fall WV actually had around 267K uninsured, of which only 143K were eligible for Medicaid expansion. Furthermore, as of mid-July, the number of Medicaid enrollees specifically designated as "due to ACA expansion" already stood at 132,556, which means that we're talking about some number between 132K - 145K...out of some other number between 143K - 150K.

In other words, West Virginia has now enrolled a minimum of 88% of those eligible for Medicaid expansion...up to a maximum of 101%!!

GAH!! That's three "solid numbers but vague definitions attached to them" articles in a row this evening:

Braley also used the debate as an opportunity to show that he has worked with Republicans such as Iowa Gov. Terry Branstad. The two worked together to expand Medicaid, giving more than 80,000 people health coverage who didn’t have it before.

OK, that makes it sound like 80K newly added to Medicaid via ACA expansion. However, in an earlier Iowa update, it made it sound like IA has some sort of Arkansas-like "private option" thing going on which had 20,000 enrolled at that time. So...is the 80K referred to above in addition to those 20K, or are they included in it?

(sigh) Again, not sure how to handle this. Anyone familiar with the Iowa Medicaid situation, please feel free to chime in below. Either way, it sounds like I can safely bump Iowa's "strict expansion" tally up from 20K to at least 80K, anyway...

Hmmm....like Hawaii, this enrollment update is a) tiny (small state) and b) confusing, since it means that either not a single additional person has enrolled in Delaware since April 30th (which I highly doubt), or it means that the number of people dropping out has precisely matched the number added since then (which I also highly doubt), or it means that the reporter got their numbers and dates mixed up by mashing up the 4/30 QHP total with the 8/31 Medicaid total:

As of Aug. 31, a total of 22,340 Delawareans have enrolled in coverage since Oct. 1, 2013, which Rita Landgraf, secretary of Delaware Health and Social Services, said came as a pleasant surprise to the commission.

...Of the enrollees in the health-care marketplace over the past 11 months, 7,943 individuals enrolled as part of the Medicaid expansion, an 8 percent increase from the month of July.

For all of the flaws with their implementation of an ACA exchange, Hawaii had at least one thing going for them during the off-season: They kept providing enrollment updates (as small as the numbers were) on a regular basis...through the end of July, that is. Since July 26th I haven't heard a peep out of HI before today:

The exchange, created by the Affordable Care Act, also known as Obama­care, has struggled with participation over the past year, attracting just two medical insurers -- Hawaii Medical Service Association and Kaiser Permanente Hawaii -- and signing up just 10,750 individuals, the lowest in the nation.

Hmmm...on the one hand, 10,750 is actually a reasonably decent increase since July (1,087 people added over about 2 months, or 18/day). On the other hand, it's entirely possible that this number includes the 1,057 SHOP plan enrollees...in which case it isn't an update at all, or (scarier) it would mean Hawaii has only added 30 people to QHPs since 7/26.

OK, all of this is moot if the new software platform proves to be as much of a mess as last year's was, but assuming the new setup works properly, this sounds like a fairly smart way of cleaning up the mess:

Open enrollment begins November 15, but individuals’ deadlines to enroll may vary.

A total of 285,000 people who currently have temporary coverage will need to re-enroll, but a proposal is in the state’s hands to do that enrollment in three waves, with three different deadlines– Jan. 15th for wave one, Jan. 31st for wave two, and Feb. 15th for wave three.

For those of you currently enrolled in a non-subsidized Affordable Care Act Plan, your deadline to re-enroll is by the end of this year, December 31st. Missing that deadline will cause you to have a gap in your coverage.

Thanks to top contributor deaconblues for jumping back into the game and providing me with a whole batch of updates this evening. First up, the DC exchange, which posted their first update in 2 months:

From October 1, 2013 to September 9, 2014, 57,883 people have enrolled through DC Health Link in private health plans or Medicaid:

14,402 people enrolled in private health plans through the DC Health Link individual and family marketplace.14,289 people enrolled through the DC Health Link small business marketplace. 29,192 people were determined eligible for Medicaid coverage through DC Health Link.

That's an increase of 1,872 QHPs, 510 new SHOP enrollees and 4,472 more Medicaid additions to date.

A federal judge in Oklahoma ruled Tuesday that Obamacare subsidies provided on the federal HealthCare.gov exchange are invalid, agreeing with a ruling by a three-judge D.C. Circuit Court of Appeals panel against the subsidies.

The ruling, along with the fallout from the D.C. Circuit decision, could be a potentially significant defeat for the Obama administration.

On the one hand, this development probably makes it more likely that the SCOTUS will end up taking on the Halbig case (from the DC Circuit Court) after all (and/or the King case from the 4th Circuit...all three appear to focus on pretty much the same "federal exchange vs. state exchange" issue).

...Factually, the claim doesn't appear to be accurate. Kentucky had 26,271 more people working last month than it did in March 2010 when President Barack Obama signed the Affordable Care Act into law, according to the U.S. Bureau of Labor Statistics. The state's unemployment rate in that same period fell from 10.5 percent to 7.1 percent.

Manoj Shanker, an economist at the Kentucky Office of Employment and Training, said the health care law "is expected to be a net gain for the economy."

"It is definitely expected to create jobs, and not just for doctors and nurses," Shanker said.

...About 3,600 additional health care jobs were created over the last year in Kentucky as places such as Perry County...saw the percentages of their population without health insurance drop from as high as 20 percent to no more than 8 percent.

Still no Medicaid update since 8/13, but Oregon's total QHP figure is up another 687 since 9/22, while NET QHPs are down 696, giving an overall attrition rate since the peak in mid-July of around 2.3% per month. Note that the net current enrollment figure is still 14% higher than the last official HHS report tally of 68,308:

WASHINGTON—Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act.

The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for.

The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers.

This morning I introduced an all-new, cleaned-up version of The Graph which only includes commercial policy enrollments via the ACA (exchange QHPs, plus references to off-exchange QHPs, ACA-enabled ESIs and sub26er enrollees), projected out through Nov. 15th (when the whole process starts all over again).

Now I've added the other half of the revamped graph: ACA-enabled Medicaid/CHIP enrollments. Like the QHP graph, there are 3 color-coded sections, but in this case they represent "Strict ACA Expansion" (people who are only eligible for Medicaid/CHIP due to the income provisions within the law in half the states); "Bulk Transfers" (ie, transferred from existing state-run programs such as LIHP in California, Commonwealth Care in Massachusetts, etc. due to ACA provisions) and "Woodworkers" (people who were already eligible for Medicaid prior to the expansion provisions, but who never enrolled before due to either being unaware of their eligibility, not understanding the process, etc). "Woodworkers" are folks who have been "drawn out of the woodwork" since last October thanks to a robust outreach program by the government and affiliated nonprofits, as well as a streamlined enrollment process and other measures.

OK, I'll be frank, this has little to do with the Affordable Care Act itself. Michigan's state legislature has already (grudgingly) passed the ACA's Medicaid expansion program (we call it "Healthy Michigan" here, and it's been very successful).

In other words, the only directly ACA-related items likely to come up over the next couple of years are presumably a) continuing support for Medicaid expansion (not sure if it has to be renewed annually or what) and b) the outside possibility of voting on establishing our own ACA health insurance exchange in the event that the Halbig/King cases end up being upheld by the SCOTUS.

Having said that, if you support me and the work I'm doing here, I'd like to ask a personal favor of you: Please help out the woman running for representative in Michigan's 40th state house district, Mary Belden.

Louise Norris of HealthInsurance.org has posted a couple of fantastic articles the past week or so. First up is an explanation of why most current healthcare policies weren't cancelled...which is to say, the insurance companies cancelled most of them for different reasons than what ACA critics are claiming:

But AV is just one of numerous factors involved in compliance with the ACA. There were many other reasons that existing plans were not compatible with the law. Of particular importance, less than 2 percent of the individual health plans in existence in early 2013 provided coverage for all ten of the ACA’s mandatory essential health benefits.

...So when policies are being cancelled and replaced with ACA-compliant coverage, AV isn’t likely to be the primary culprit. Virtually no individual policies that were in effect prior to 2014 are compliant with the ACA, for a host of reasons other than AV.

Hmmm...now this is interesting. Yesterday it was brought to my attention via Twitter that the Covered California website (or at least the actual off-season enrollment portion of it) had been offline for "2+ weeks". Sure enough, when I took a look for myself, after clicking past the home page, the enrollment section had a message saying that it was offline for maintenance but that I should "check back on September 15th". Of course, seeing how it was Sept. 28th when I read this, that suggests that the maintenance started sometime before the 15th and continued well past the estimated completion date.

As we approach the 2nd Open Enrollment period, and as The Graph has become far too unwieldy to keep laid out in its current format, I've decided to break out the commercial plans (Exchange-based QHPs, plus references to the off-exchange QHPs, ESIs via SHOP exchanges/etc. and "sub26ers") onto their own graph. As you can see, this allows me to add another important new feature: My projection of the currently enrolled/paid up figure at any given time. We're also close enough to Year Two now (and my projections to date have proven accurate enough so far) that I'm comfortable projecting the QHP graph forward through November 15th (at which point Year Two starts up).

The 11/15 projections (as well as the "currently enrolled" line) assume a 9,000 new enrollments per day, a 90% payment rate, and a 2% average monthly attrition rate. This lines up almost precisely with the recent CMS announcement that 7.3 million people were currently enrolled & paying as of August 15th.

OK, I feel a bit silly posting this several days after HHS Sec. Burwell stated it officially, and it may seem especially anticlimactic given that I had already posted similar numbers from not one, not two, not three, not four, but five different respected national health insurance coverage surveys a couple of months ago (RAND Corp, Gallup, Urban Institute, Commonwealth Fund and the New England Journal of Medicine, to be precise), but it still seems like a good idea to lock this down for the record:

Taking questions yesterday from reporters for the first time at a White House news conference, HHS Secretary Sylvia Mathews Burwell said insurance programs created by the Patient Protection and Affordable Care Act have reduced the nation’s uninsured population by 26 percent. She called the reduction “the most important number” to measure the law’s success.

Health exchange managers expect to lose about 30 percent of enrollees due to attrition by year’s end.

That means they’ll carry over about 114,000 existing customers as they head into the 2015 open enrollment season.

Connect for Health Colorado managers expect enrollments to slide back from a total of 146,000 so far.

...Of the 146,000 people who signed up by the end of August, exchange managers said 10 percent dropped out right away, never paying their first month’s premium. Then about 20 percent more leave in subsequent months.

The new GAO study shows that, instead, taxpayers are subsidizing abortions. Customers in five states have no abortion-free plans available to them, and in many states, customers can't tell which plans cover abortion and which don't.

...Fifteen issuers and the Washington Health Benefit Exchange ... did not itemize the premium amount associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they send a separate bill for that premium amount.

Beneficiaries with Healthy Michigan Plan Coverage: 395,547
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 22, 2014

...but there's an even more recent figure given today, as GOP Governor Rick Snyder tries to take credit for the program (note that the article doesn't mention "Obamacare" or "the Affordable Care Act" anywhere in it):

LANSING, Mich. (AP) — Just over 400,000 low-income adults in Michigan have signed up for Healthy Michigan, the state’s Medicaid expansion program.

In addition, the original estimate of the maximum eligible number of MI residents was apparently a bit high (500K); evidently the actual number is slightly lower...meaning that the percentage reached is even better by comparison:

A couple of weeks ago, I reported that Maryland, which was one of the states which had embarrassingly bad technical problems with their ACA exchange--and which ended up scrapping their platform completely and moving to an all-new system based on Connecticut's excellent platform--was making some very wise decisions for 2015 based on lessons hard-learned from 2014:

BALTIMORE (Tuesday, Sept. 16, 2014) — The second year of Maryland’s health insurance marketplace for individuals and families begins on Nov. 9 when consumers will have access to a newly redesigned website that enables “anonymous browsing,” the ability to compare plans — without registering personal information — before enrolling. This feature is being launched earlier than originally planned to enhance the shopping experience for Marylanders.

One of the bigger concerns about the ACA was that the reduction in uninsured rates wouldn't be felt among the Hispanic community in particular. Instead, that demographic appears to be outpacing the general populace:

The federal healthcare law has dramatically increased coverage among Latinos, according to a new report that provides a comprehensive look at the effects of the Affordable Care Act on a historically underinsured community.

Overall, the percentage of Latinos ages 19 to 64 lacking health coverage fell from 36% to 23% between summer 2013 and spring 2014.

That's a reduction of 13 percent points, or 36% among non-elderly adults.

By comparison, the overall reduction nationally has been from around 20% down to 15%...or roughly a 25% drop.

The Obama administration is projecting that hospitals will face $5.7 billion less in uncompensated care costs than they otherwise would have in the first full year of the Affordable Care Act's coverage expansion.

Millions more people with health insurance means fewer uninsured patients are coming through hospitals' doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation's hospitals in 2012.

OK, so obviously the hospitals are thrilled about this, but what about the rest of us? Well, in theory, those savings should be in turn passed along in the form of lower premiums/co-pays/etc. (or at least a slower rate of increase, anyway):

Thanks to contributor Bob H. for bringing my attention to a new ACA budget study which claims that the Healthcare.Gov federal exchange has cost more than $2 billion to date, and that the total cost of the ACA since 2010 has reached $73 billion:

The total price tag for ObamaCare's main enrollment portal now stands at more than $2 billion, according to a new analysis by Bloomberg Government.

The new total, released Wednesday, includes efforts to construct and then fix HealthCare.gov after serious technical problems threatened to shutter the site last fall.

In all, implementation of the Affordable Care Act has cost more than $73 billion since its enactment in 2010, the analysis found.

I'm not going to get into the "$73 billion" part, since that includes a lot of questionable budget items such as around $14.5 billion of it being exchange premium subsidies (that is, I'm not saying those amounts are wrong, but it's highly questionable whether they should be counted as the "cost" of the law itself). This point is made in the same article by CMS itself:

OK, kind of a snarky headline I realize. This is actually a very good article by the Washington Post's Jason Millman, which goes beyond the actual number of people newly added to the Medicaid rolls since January thanks to the Affordable Care Act (by my count it's up to around either 6.5 million or 9.7 million, depending on whether you include "woodworkers" or not), but the quality of that coverage.

The good news is that, unsurprisingly, people are pretty relieved to finally have decent healthcare coverage, in many cases for the first time in their lives:

Pop Quiz: You're writing (or editing) a news story about a GAO report regarding the security situation at Healthcare.Gov. Which of these passages from the article do you choose for your big, bold-faced headline?

OK, this one doesn't fall so much into the "another ACA attack debunked!" category as the "vastly overblown" category:

Narrow networks were a popular health insurance option on the exchanges in the first enrollment period, with half of all plans for individuals offering limited groups of lower-cost providers, and new research shows consumers generally aren't griping about the products.

...Health insurers have said the healthcare reform law is spurring them to offer more narrow networks, which they say save them money and lead to lower monthly premiums in exchange for a smaller number of in-network hospitals and physicians.

After speaking with several state officials and insurers that offer exchange plans, researchers found that few consumer complaints have emerged to date about the networks' offerings.

“Insurance companies calculated that consumers would be willing to trade greater provider access for lower premiums, and to a large extent, our research confirms that,” said Sabrina Corlette, the report's lead author, in a statement.

Among the five insurance carriers participating in the exchange, premiums will drop on average by 7 percent at Molina Healthcare, 1.5 percent at New Mexico Health Connections and 1 percent at Blue Cross and Blue Shield of New Mexico, according to the state Office of the Superintendent of Insurance.

The highest, lowest and roughly mid-range monthly payments for HMO health insurance plans offered by companies participating in the New Mexico Health Insurance Exchange. The payments are based on charges for a 50-year-old, non-smoking resident of the Albuquerque metro area for 2015. For more information, go to the exchange website atwww.bewellnm.com.

Premiums will be unchanged at Presbyterian Health Plan. The fifth insurance carrier participating in the exchange, Christus Health Plan, is in its first year.

...Health plans available to small businesses on the law’s new health marketplaces are on average about 7 percent cheaper than comparable plans offered elsewhere, according to analysis conducted by a team of researchers at the National Opinion Research Center at the University of Chicago. For middle-tier plans, for instance, the disparity translates into about $220 in annual premium savings for plans purchased on the SHOP exchanges.

Bringing together two of the best-known brands in insurance, State Farm said it would partner with Blue Cross Blue Shield plans in five states to sell Blues brand individual medical policies when signup begins in November for private coverage under the Affordable Care Act.

The relationship will marshal an army of more than 3,300 State Farm agents to sell Blue Cross plans in Illinois, Texas, Montana, Oklahoma and New Mexico. Financial terms of the deal between State Farm and Health Care Service Corp., the parent of the five Blues plans, weren’t disclosed but executives said State Farm offices, known better for their auto and home insurance offerings, will begin to offer individual health insurance policies beginning Nov. 15 for coverage that will begin as early as Jan. 1, 2015.

Back in May, you may recall that I called attention to an appallingly offensive and cruel law which the Michigan state legislature (fully controlled by the Republican Party) passed which effectively subjects up to 200 rape victims per year to cruel & unusual punishment (and/or a $500 fine) for the "crime" of being, you know, raped:

At first glance, my headline above might seem to have a typo; according to the story itself, the actual increase is a whopping...1.18%, nearly a full percent higher! Busted, right?

Health insurance premiums next year will increase only about 1.18 percent on average statewide next year.

That’s according to the Colorado Division of Insurance after it reviewed and approved 1,072 health insurance plans from 20 carriers that will offer health coverage to consumers and small businesses next year.

None of the nine Deep South states with the highest rates of new HIV/AIDS diagnoses — Alabama, Georgia, Florida, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas — has opted to expand Medicaid under the Affordable Care Act. Those states also have the highest fatality rates from HIV in the country, according to the coalition.

Not expanding Medicaid is literally helping spread HIV.

“People who don’t have Medicaid or other health-care coverage rarely visit primary-care doctors and aren’t getting tested for HIV, according to Michael Saag, an HIV/AIDS researcher with the University of Alabama at Birmingham School of Medicine,” Wiltz explains.

Ever since the 2014 ACA open enrollment period ended in April and the hoopla over this site and my bean-counting died down, I've been wondering whether what I'm doing here is still relevant. After all, as I noted many times last winter/spring, I never intended on keeping the site live and active this long; my original plan was to shut it down sometime in late April, Mission Accomplished and all that.

However, stories like this one reassure me that the need for up-to-date, accurate information regarding ACA data is still alive and well.

"I’d go back to the pre-Obamacare baseline is what I would do. I think that’s the way to go. We shouldn’t assume we’re going to have an explosive entitlement then replace it with our own. I would start over again, quite frankly."

What Ryan was suggesting is that if Republicans take control of the Senate, they are going to begin the process of repealing Obamacare. The real target date that Republicans have in mind is 2017. If Republicans control Congress and win the presidency, they will be able to repeal the ACA and replace it with a voucher system.

Pretty minor Oregon update today, with no Medicaid update and total QHPs up around 800; the main significance is that the net QHP enrollment, having gradually dropped every week since around mid-July, has leveled off at 78,616 for the past 2 weeks:

A report released today by the Department of Health and Human Services shows that consumers will have more choices as they shop for quality, affordable coverage on the Health Insurance Marketplace in 2015, because there will be a net 25 percent increase in the number of issuers offering Marketplace coverage in 2015. In total, 77 new issuers will offer Marketplace coverage.

“When consumers have more choices, we all benefit,” said Secretary Sylvia M. Burwell. “In terms of affordability, access, and quality, today’s news is very encouraging. It’s a real sign that the Affordable Care Act is working.”

Today’s report examines preliminary data from 36 states run or fully supported by the federal government (Federal Marketplace) plus eight states operating State-based Marketplaces, and finds that a larger set of insurance issuers will offer plans in the Marketplaces in 2015. Specifically:

(sigh) I debated whether to respond to the latest nonsense spewed forth by FOX News' Jim Angle (he's their "chief national correspondent", don'cha know?), since I've already pre-debunked (pre-bunked??) pretty much every mouse pellet that he drops in this article, but what the hell:

President Obama’s claim last spring that 8 million people had enrolled in ObamaCare recently got a significant downgrade from the head of the agency overseeing the plan.

STOP: No one enrolls "in" ObamaCare. They enroll in either a commercial healthcare policy via a healthcare exchange providede for by the Affordable Care Act or they enroll in Medicaid or CHIP thanks to provisions within the Affordable Care Act.

No, Tavenner did not give a "significant downgrade". She was actually quite happy (and rightly so) to report that a good 90% or so of ACA QHP enrollees have paid their first month's premium and continue to do so from month to month.

OK, I suppose there have been worse U.S. Senate candidates in the past, and it's conceivable that there are worse ones this year thrown in by one major party or the other as "Some Dude®" sacrificial lambs in deep Red or Blue states. However, Terri Lynn Land is certainly the worst "serious" contender this cycle that I can think of.

Anyway, Land, who somehow managed to win statewide office twice as Michigan's SOS in the past, has apparently decided that 630,000 of her potential constituents shouldn't have decent, affordable healthcare coverage, so she's signed a pledge vowing to repeal the Affordable Care Act.

Well, OK, technically this isn't the same lawsuit that Speaker of the House John Boehner (that's "John Boehner", by the way, not "Ted Cruz" or "Mitch McConnell") is still supposedly planning on filing against President Obama, but it might as well be:

A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president.

This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue.

Minnesota's QHP numbers continue to quietly rise slowly despite the news last week that the MNsure's largest participant, PreferredOne, is pulling out of the exchange for year two. Meanwhile, their Medicaid number is up another 6,541, and MinnesotaCare (which isn't actually Medicaid proper, but is sort of a quasi-Medicaid-like program allowed for & funded by the Affordable Care Act) is up 1,489.

I've generally sort of lumped Medicaid and MinnesotaCare together, but it's worth noting that the successful addition of 73.4K people to MinnesotaCare is one of the main reasons for PreferredOne pulling out of the exchange in the first place.

For the most part, this press release from CoveredCA is just a nice overview of the new offerings available on the little-discussed SHOP (small business) ACA exchange. As you may recall, CA was one of the few SHOP exchanges which ever got off the ground at all last year, and even then technical issues resulted in the exchange taking it offline back in February. When I last updated CA's SHOP total, it was at only 4,900 people...however, according to this PR, that number has more than doubled since last spring, and now stands at 11,510:

Sept. 19, 2014

COVERED CALIFORNIA ANNOUNCES INSURANCE PLANS FOR SMALL BUSINESSES IN 2015

Carriers Remain Consistent, but New and Expanded • Choices Are Now Available to Employees

Apparently some insurance companies haven't been complying with the byzantine hoops that anti-choice forces demanded be included in the Affordable Care Act (although for the most part they still voted against it anyway):

The new GAO study shows that, instead, taxpayers are subsidizing abortions. Customers in five states have no abortion-free plans available to them, and in many states, customers can't tell which plans cover abortion and which don't.

...Fifteen issuers and the Washington Health Benefit Exchange ... did not itemize the premium amount associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they send a separate bill for that premium amount.

WASHINGTON — A Senate hearing on Tuesday set the stage for a coming debate over whether the federal government should continue financing a popular health insurance program for lower-income children who are now eligible for new coverage options under the Affordable Care Act.

The Children’s Health Insurance Program, known as CHIP, has helped cut in half the uninsured rate for children, to about 7 percent in 2013 from 14 percent in 1997, when it was enacted. It provides coverage for about eight million children in families that earn too much to qualify for Medicaid, the government health care program for the poor, but cannot afford private coverage.

Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

Joe Sonka has an excellent (if depressing) analysis explaining why Kentucky Senate candidate Alison Lundergan Grimes isn't campaigning on the Affordable Care Act even though her opponent, Mitch McConnell, has done everything he can to tear away healthcare from a half-million Kentuckians:

The reasons for this disconnect are many and are closely tied to the decision of Alison Lundergan Grimes’ campaign to steer clear of the issue. But this decision by Grimes to avoid talking about the benefits of health care reform is not just an effect of the disconnect, it is also a cause of the disconnect, itself.

It's been over 3 months since I've been able to check in on the status of Ohio's implementation of ACA Medicaid expansion. As of mid-June, OH had racked up 243,230 people newly eligible thanks to the Affordable Care Act out of around 563,000 state residents who were eligible.

As of the end of August, that number has grown to 367,395 people, or over 65% of the total eligible:

Kasich told taxpayers and the Ohio General Assembly that an estimated 366,000 Ohioans would be enrolled in Medicaid under Obamacare at the start of the state’s 2016 fiscal year. This projection is reflected in a Governor’s Office of Health Transformation chart released in February 2013.

I'll give you a minute to get over the shock of that headline (and really, McArdle is the one who I've ripped onbefore, not Laszewski).

While I've been pretty much vindicated regarding the (eventual) 1st month premium payment rates, off-season enrollment rates and monthly attrition rates for exchange QHPs, there have still been two items which have bothered me.

Even after yesterday's Big 7.3 Million Currently Enrolled News (or perhaps because of it), there's still tremendous confusion about what that number actually means. In addition, there's been some ongoing confusion about some other numbers relating to the ACA exchange qualified healthcare policies (QHPs), so here's a rundown, in descending order, based partially on existing data and partially on my projectionsthrough November 15th (that's when the 2nd Open Enrollment period starts for coverage beginning on January 1st, 2015, making the current enrollment numbers partially moot).

As you can see, depending on what question you're trying to answer, what you feel should "count" and what your political spin is, there are up to 12 different numbers (!!!) which you could conceivably "use" for your answer.

As I've stated many, many times before: In spite of their $300 million disaster of a website failing to enroll a single person, Oregon has still managed to rack up one of the most impressive enrollment tallies in the entire country relative to their population, with a grand total of over 481,000 people added between QHPs, Medicaid and CHIP (in addition to the 353,000 noted at the link, OR added another 128K to Medicaid via their "fast track" program which they don't list here for whatever reasons).

For a state with only 3.9 million people, that's bound to have an impressive impact on the uninsured rate...and sure enough...

Another Big Number story today on top of the national and Illinois ones. My most recent numbers for California Medicaid expansion had it pegged at around 1.4 million "strict expansion" and around 600K "woodworkers" as of late June. However, that was just an estimate.

This article about a class action lawsuit being filed over the massive Medi-Cal backlog (down to 350K from a whopping 900K back in May) is mostly negative for obvious reasons. However, there's an interesting data point in the middle of it:

According to state officials, 2.2 million new Medi-Cal members were added as a result of the Obamacare healthcare expansion, bringing the total number of participants in the program to about 11 million.

State Department of Health Care Services spokesman Norman Williams said that as of Sept. 1, 350,000 applications remained backed up in the enrollment system. That system has been plagued by computer troubles that have stymied county government efforts to verify patients' Medi-Cal eligibility.

Now, before anyone claims that I'm "wrong" about the paid number being 7.3 million instead of 8.07 million, read the tweet carefully: I says that 7.3 million were enrolled as of August 15th. In other words, that's the net number after subtracting those who've dropped their coverage after 1, 2, 3 or more months.

OK, so those are the current enrollment numbers. 76,094 QHPs is 4% net attrition from the 4/19 total of 79,192, or less than 0.8% per month, which is fantastic.

However, since that 76K figure combines both additions and subtractions (ie, it's the net total, not gross), I can't really tell what the cumulative total is, which is what I use for my off-season projection chart.

Washington hospitals provided nearly $154 million less in charity care in the first half of this year than in the first half of 2013, in many cases boosting the hospitals’ bottom lines.

Hospitals attributed the plunge in charity care — about 30 percent — to the Affordable Care Act’s focus on reducing the number of uninsured patients.

This year, for the first time, low-income and uninsured patients whose care was previously covered under hospitals’ charity-care programs were able under the ACA to qualify for Medicaid coverage or subsidized private insurance.

Unfortunately, I don't know the market share breakdown, so I can't do a weighted average, but the DC Health Link exchange rates for 2015 have been released, and the unweighted average is only a 2.3% increase for the individual market. For the SHOP (small business) exchange the news is even better...a decrease of over 2% (again, unweighted). The SHOP rates carry a lot more heft in DC than in most states due to the unique rules in place there (like Vermont, all individual enrollment has to be done via the ACA exchange, and all Congressional staffers are required to enroll via the DC SHOP system):

The D.C. Department of Insurance, Securities and Banking today announced the approved health insurance plan rates for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2015.

Ouch. While most states are seeing their list of insurance providers increasing this year, in a few cases some are dropping out...and in the case of Minnesota, it's the one with 59% of current enrollees:

The insurer with the lowest rates and most customers on Minnesota's health care exchange is pulling out.

Golden Valley-based PreferredOne this morning confirmed its exit from MNsure. It comes as a major blow to the exchange — the next open enrollment period starts Nov. 15 and runs through Feb. 15.

MNsure officials said the online insurance exchange would reach out soon to PreferredOne customers who bought coverage through MNsure last year with information on next steps.

They said consumers still have at least four, well-known, Minnesota-based carriers "who are committed to providing important health coverage" to everyone, including people who qualify for tax credits and public programs.

...According to a company statement, MNsure policies make up only a small percentage of PreferredOne's entire enrollment but take up a significant amount of resources to support.

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice – – -
though the whole house
began to tremble
and you felt the old tug
at your ankles.
‘Mend my life!’
each voice cried.
But you didn’t stop.

Reason.com is a pretty conservative outlet, but Peter Suderman has an entry which asks some refreshingly valid questions. He starts with an overview of the report released yesterday by the CDC, which noted an overall drop in the uninsured number by about 3.8 million as of the end of March. To his credit, he follows up by calling attention to the fact that this doesn't include over half of the total QHP enrollments (as well as a lot of Medicaid additions):

But this survey probably doesn’t measure the full impact of the law. That’s because the survey was conducted from January through March of this year, when Obamacare’s open enrollment period was still ongoing. So it wouldn’t capture much of the last-minute enrollment surge that accounted for a significant portion of the sign-ups under the law. People who signed-up at the end of March, or in the extended enrollment period in early April, wouldn’t have technically been insured for another month or more.

When I last updated Kentucky's numbers on August 8th, Gov. Beshear had just repeatedly stated the latest number of people enrolled via the Kynect exchange as 521,000. He didn't break this out between QHPs and Medicaid, but I used a conservative estimate of around 91K & 430K respectively. Today, the Lt. Governor gave a similarly non-broken-down update:

Kentucky Lt. Gov. Jerry Abramson talked about Kynect earlier today during an appearance at the Kentucky Medical Association's annual meeting. At the event, he said implementing an exchange was necessary because it increased access to health care in our very unhealthy state. He said 527,000 signed up for coverage, primarily through Medicaid, which was also expanded.

Like some other states, Maryland has made some poor decisions when it came to setting up their ACA exchange last year, necessitating scrapping the original platform and replacing it with a customized version of Connecticut's much better system. While it remains to be seen how well the 2nd attempt will function, this is a very smart move on their part:

BALTIMORE (Tuesday, Sept. 16, 2014) — The second year of Maryland’s health insurance marketplace for individuals and families begins on Nov. 9 when consumers will have access to a newly redesigned website that enables “anonymous browsing,” the ability to compare plans — without registering personal information — before enrolling. This feature is being launched earlier than originally planned to enhance the shopping experience for Marylanders.

...Starting November 9, the redesigned exchange will be rolled out with a series of events, including a more intensive campaign of in-person assistance to help consumers and businesses during the upcoming season of open enrollment:

On the one hand, Vermont's ACA exchange still has serious technical flaws heading into the 2nd open enrollment period this November. On the other hand, under the circumstances, this is probably the smartest move to make right now:

The Vermont Health Connect website went down Monday night and will remain offline for several weeks to allow for improvements to the user experience and data security, state officials said Tuesday.

Customers who need to report changes in income or make changes to their coverage or personal information will need to contact the customer service call center.

...None of the major functions that are still being developed will be launched when the website comes back online, said Lawrence Miller Chief of Health Care Reform.

The timeline for remaining elements, such as online changes to coverage or personal information or allowing small businesses to use the site has not changed.

Beneficiaries with Healthy Michigan Plan Coverage: 385,541
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 15, 2014

Yup, that's up another 9,800 in the past week. With roughly 500,000 Michiganders eligible for the ACA Medicaid expansion program, my state has reached 77% of the total potential enrollment in just 5 1/2 months.

The percentage of people without health insurance coverage for the entire 2013 calendar year was 13.4 percent; this amounted to 42.0 million people.

Remember, that's before any of the ACA exchange enrollments took effect starting in January 2014, and is also before any Medicaid expansion took effect (also January 2014 for most states; Michigan didn't start until April, and New Hampshire didn't start until July).

It's important to note that the Census Bureau has changed their methodology with this report, so it's difficult to do a true "apples to apples" comparison with prior years. However, they do include the following note:

According to the American Community Survey, the percent of people without health insurance coverage declined 0.2 percent between 2012 and 2013.

So, as Dylan Scott at TPM noted yesterday (and as I noted in kind), the Census Bureau is expected to release a Big Report at 10am with insurance coverage data. However, it turns out that the CDC (Centers for Disease Control) beat them to the punch by releasing their own report at midnight:

Obamacare cut the share of people in the U.S. without health insurance by two percentage points this year, the Centers for Disease Control and Prevention said in a report today.

In the first three months of 2014, 18.4 percent of adults under age 65 lacked health insurance, down from 20.4 percent last year, according to the CDCsurvey. The fall in the uninsured rate was helped by 3.7 million people who bought private health insurance sold under the Patient Protection and Affordable Care Act, the CDC said.

So, here's the big news from CMS/HHS today: Remember the 966,000 people whose citizenship/immigration data didn't match up last May? Well, they've managed to resolve about 851,000 of those cases, yay! Also, remember the 1.2 million households with discrepancies regarding their income levels? Well, that represented about 1.6 million actual people, and they're reporting having resolved about 897,000 households, leaving around 279K to go (representing 363,000 individuals).

Assuming these numbers don't overlap (and they probably do in a few cases), that means CMS has worked through about 2.088 million data discrepancies, leaving around 478K to go. So...yay, team and all that.

As for those who remain, the 115K with immigrant/citizenship status issues need to send their correct documentation to Healthcare.Gov by the end of September to avoid losing coverage. They did say that there would be some sort of special enrollment period for those folks as long as they keep paying their premiums, but they were pretty clear about the September 30th deadline.

At 10 a.m. Tuesday, the Census Bureau will release a new report on health insurance in America.

...The problem with the new numbers, according to the Kaiser Family Foundation's Larry Levitt, is that the Census Bureau's survey cuts off at March 31. That means 3 million people-plus who signed up in the law's final weeks of enrollment will still count as uninsured, even though they have since been covered.

"I think it’s fair to say tomorrow’s release will be essentially meaningless in judging the effects of the Affordable Care Act," Levitt told TPM in an email.

As an aside, I also question the wisdom of not requiring everyone to re-enroll each year. Obviously HHS is trying to minimize the inconvenience/hassle factor, but it seems to me that this is just going to cause even greater confusion than it would if they simply issued a blanket statement: If you enrolled via an ACA exchange, you have to renew once a year even if nothing else has changed.

I don't see doing this as a big deal; people have to renew their license plates every year even if it's for the same car, for example.

"We get into a very dangerous situation if we just tell everybody they can just auto-enroll," Houchens said.

Again, all of this is avoidable. These are the risks of auto-renewal. Anyone who goes back in to HealthCare.gov to get a new eligibility determination will see their updated subsidy as well as the current list of available plans.

I'm about to show you a chart which demonstrates several noteworthy things about QHP enrollment in Oregon (which, in spite of the terrible technical problems their site has had, has managed to enroll a similar ratio of their uninsured residents in private policies (around 34%) via their exchange to Kentucky, which is considered one of the most successful exchanges).

Last week I noted that the "OMG!! GAZILLIONS OF POLICIES CANCELLED!!!" freakout over non-ACA compliant healthcare policies being sunsetted to be replaced by policies which are compliant with the law is about to raise its ugly head again this fall. Sure enough, we're off and running in Virginia:

After a year’s reprieve, up to 250,000 Virginians will receive notice by the end of November that their health insurance plans will be canceled because the plans do not comply with the Affordable Care Act and accompanying state law.

The affected policyholders were allowed to renew their old plans late last year, even though the plans did not provide all of the benefits required under the health care law, but they won’t have that option when the policies expire this year.

I went with 240K instead of 250K because later in the article it says:

OK, I admit that aside from tracking the actual enrollee numbers, I don't know a whole lot about the inner workings of Medi-Cal, California's version of Medicaid. However, if accurate, this just sounds...wrong:

I posted a diary here on August 26 about California turning Medi-Cal into a long term loan for recipients aged 55+ by billing their estates after they die for all of their Medi-Cal expenses. The bureaucrats call that “estate recovery.” I call it legal theft. A bill to remedy this situation and protect low income property owners has unanimously passed the California legislature. The bill has now gone to the governor to be signed. But he is planning to veto it!

Today, many organizations are jointly sponsoring a call-in to the governor's office to put pressure on Governor Brown to sign SB 1124. More information about the call-in is at the bottom of this diary. But first, some background information.

Three important pieces of information about Nevada's exchange out of this article:

1. NV's move to HC.gov will be permanent. The original plan was to only move to the federal exchange for 2015, then moving back to their own (2nd attempt) platform for 2016, which frankly always sounded a bit silly to me. There were lots of reasons for the states to run their own exchanges originally (federal cash to do so, autonomy/local control, etc.), but the federal funding will have dried up by then, and if everything is running smoothly at HC.gov, I'm not sure I see the point in uprooting the whole system at that point. Frankly, there's really only one major reason I could see to move back to their own platform, but...

2. While NV will be using the HC.gov software platform, they'll still legally be considered a state-run exchange, which means that they're safe from any potential SCOTUS Halbig/King fallout. This is basically the entire point I was making way back on July 2nd with my "Domain and a Splashpage" solution.

Without an Obamacare critic to talk to, Klepper turned to a nurse who lost her free clinic job because her patients could finally get health coverage. And she was thrilled about that turn of events. Now, she told him, she was focusing her efforts on other causes, like human trafficking.

On the one hand, I always thought that reducing healthcare spending was supposed to be a good thing. On the other hand, apparently to most economists, increasing spending overall is supposed to be a good thing. So...um...ok, then:

WASHINGTON (Reuters) - The U.S. economy likely grew at a much faster pace in the second quarter than previously estimated, according to data on Thursday that showed a big jump in healthcare spending.

The Commerce Department's quarterly services survey, or QSS, showed healthcare outlays increased at a much brisker clip than the government had assumed in its last estimate of gross domestic product in late August.

As a result, economists said healthcare spending could add as much as three-tenths of a percentage point to second-quarter GDP growth, taking it to as high as a 4.7 percent annual rate.

It's been awhile since I've beaten up on Mitch McConnell (R-Yertle) for his cognitive dissonance when it comes to somehow keeping "Kynect" (ie, the Affordable Care Act) while simultaneously repealing "Obamacare" (ie, the Affordable Care Act).

As I noted back on May 29th, "McConnell is utterly full of crap. He knows it, Grimes knows it, the Kentucky media knows it; he's just hoping that the voters of Kentucky are too stupid to know it."

At the time, the Kynect ACA exchange had enrolled around 413,000 people. Since then, the number of Kentuckians enrolled via "Obamacare" has risen to over 521,000 (and even that was over a month ago; it's likely past the 550K mark by now).

As I've noted before (and as others, such as Greg Sargent of the Washington Post have confirmed), when it comes to the Affordable Care Act, the Republican Party has been reduced, at this point, to literally running against the word "Obamacare" instead of the actual law itself.

By this point in the 2014 campaign cycle, those of you with any sense have moved from running away from the Affordable Care Act to going on offense by not only defending the law but actively pointing out the benefits that it's bringing to your constituents (or at the very least actively countering bald-faced lies about it from your opponent).

Of course it would've been even more "win, win, win all around" if they'd just done this 9 months ago, but I'll take it...

The Obama administration has agreed in concept to Utah’s novel alternative to expanding Medicaid, including the notion that able-bodied people who get insurance subsidies should accept the state’s help with finding work, Gov. Gary Herbert said late Tuesday.

The governor said after a meeting with Sylvia Burwell, secretary of the Department of Health and Human Services, that a final agreement is two or three weeks away.

HHS did not agree that insurance subsidies would be contingent on recipients holding a job or looking for work, but the agency did agree that employment can be a goal of Utah’s program, Healthy Utah.

"It’s a win, win, win all the way around," the governor said, describing the negotiations as resulting in federal approval of 95 percent of his Healthy Utah plan.

The estimate of how many Utahns would be eligible ranges from 54K - 75K; I have it down as 61K, right in the middle.

Michigan's ACA expansion program has understandably slowed down, adding only 2,573 more people over the past 2 weeks, but it still deserves kudos for breaking 75% of the total Michiganders eligible (500K) in only a bit over 4 months.

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 375,744
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

Menlo Park, Calif. – Average annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, continuing a recent trend of modest increases, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey released today. Workers on average pay $4,823 annually toward the cost of family coverage this year.

This year’s increase continues a recent trend of moderate premium growth. Premiums increased more slowly over the past five years than the preceding five years (26 percent vs. 34 percent) and well below the annual double-digit increases recorded in the late 1990s and early 2000s. This year’s increase also is similar to the year-to-year rise in worker’s wages (2.3 percent) and general inflation (2 percent).

There's a whole section which goes into the impact of the ACA on this trend:

Contributor ArcticStones forwarded this to me. I'm not in a position to either confirm or debunk many points in this article, but a quick search of this site for "Massachusetts Limbo" will bring up a number of references made in it. The author is a quite open Republican activist. However, if his claims are correct--and the bulk of them certainly seem to be--then those in charge of the first version of Massachusetts' ACA exchange should be held accountable for some rather appallingly bad decisions before, during and after the 2014 open enrollment period.

I generally support the Affordable Care Act, and states like Kentucky, Connecticut and (for the most part) Washington State, New York, Rhode Island and Colorado have proven that when the technology, budget, personnel and other project aspects are handled properly, it can be extremely successful. However, that also means not turning a blind eye or blaming the wrong source when things go wrong...and in the case of states like Oregon and Massachusetts, things did indeed go very, very wrong.

The benefit packages of lower-cost bronze and silver-level health plans — sold through the state's health insurance exchange — aren't as expensive as they might seem at first, they say.

Carolina Coleman, the project's research director, and John Connolly, the nonprofit's deputy director, say that many consumers who focus only on their high deductibles may be missing some gems hidden in their existing policies.

...With out-of-pocket costs rising, Weinberg of the Bay Area Council says, patients need to take a more active role in navigating their benefits.

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

Beyond that [the 25,000 people being added to Medicaid], the strategy seeks to chip away at the ranks of the uninsured, by enrolling them in programs they already qualify but haven't signed up for. The state will launch a website to help Virginians enroll in health care coverage through existing programs such as Medicaid and will step up efforts to sign up more Virginians for the federal health insurance exchange, HealthCare.gov.

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.

Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”

a) My son has a 102° fever & is home sick from school
b) My ISP connection is down and I'm posting this from my iPhone
c) I'm swamped with work from my day job and have to focus on that the best I can
d) All of the above

The Republicans controlling the Virginia state legislature have been fighting tooth & nail to prevent 400,000 of their fellow Virginians from receiving healthcare, but Democratic Governor Terry McAuliffe has finally found a way to squeeze 25,000 people onto Medicaid anyway by reshuffling the deck of existing executive regulatory rules:

RICHMOND — Gov. Terry McAuliffe (D) on Monday unveiled a plan to insure an additional 25,000 Virginians, a measure that falls far short of his vow to defy the Republican-controlled legislature and find a way to expand coverage to 400,000.

After losing a months-long Medicaid fight in June, McAuliffe declared that he would close the “coverage gap” on his own.

On Monday, he announced a much more modest series of proposals, primarily designed to improve care for people already in Medicaid and boost outreach efforts to people who already qualify for it, but are not enrolled.

The plan would change enrollment criteria for about 25,000 people, including 20,000 who are severely mentally ill and 5,000 children of state employees.

This is a fairly short article. The thing that's noteworthy about my "weighting" is that I had to combine both the individual QHPs as well as VT's SHOP enrollments due to the unique situation in that state (it's a long story). QHPs + SHOP = around 66,600 paid enrollees as of the end of July. Since BCBSVT has 65K of those (over 97%), that gives a weighted average increase of around 7.8%.

Again, the other important things to note are that 1) this is still well below the "double-digit spikes!!" that nay-sayers have been screaming about for the past year, and 2) it's also around 20% lower on average than what the insurers had originally requested (weighted average).

MONTPELIER — People who buy their health insurance through the Vermont Health Connect website are going to be seeing their rates go up.

On Tuesday, the Green Mountain Care Board authorized Blue Cross and Blue Shield of Vermont to increase its rates an average of 7.7 percent while MVP subscribers will see their rates increase 10.9 percent.

Blue Cross, the state’s largest health care insurer with about 65,000 customers enrolled through Vermont Health Connect, had requested an increase of 9.8 percent while MVP asked for 15.3 percent.

Wow! This article is from back in June, but it's a heck of a find; insurance-tracking website HealthPocket ran an extensive study comparing the ACA exchange-based policies against their off-exchange equivalent plans, and their findings were pretty striking (and I'm surprised that this hasn't received more coverage):

Overall the least expensive metal plans from United Healthcare, Aetna, Cigna, and Assurant were significantly more expensive than the least expensive metal plans available on state exchanges. Across the bronze, silver, and gold metal tiers, the least expensive plans offered by the four off-exchange carriers were over 40% more expensive on average than the least expensive plans on the exchanges. This suggests that if these carriers entered new exchanges in 2015, then they would not usually be competitive with the cheapest on-exchange plans unless they substantially lowered their current premiums. It is important to note that these premium costs do not factor premium subsidies, which are only available for on-exchange metal plans.

OK, I don't know what the requested rate changes for 2015 were in Oklahoma, but this appears to be the final word:

Health Insurers Submit Exchange Rates for 2015

OKLAHOMA CITY –Oklahomans shopping for individual health insurance policies through the federal exchange will be able to choose from six different companies offering multiple plans. Rate renewals for 2015 policies range from a decrease of 9.1 percent to an increase of 29 percent. The actual rate for an individual will depend on several factors, including age, geographical location and tobacco use.

“In the second year of the federal exchange, carriers have adjusted their rates to adequately reflect their utilization costs, comply with federal rules on medical loss ratios and reflect revisions to their provider networks,” said Oklahoma Insurance Commissioner John D. Doak.

Thanks to Objective Politics for reminding me of this ugly moment from the 2012 GOP primaries...

The context was a Twitter discussion between LA Times reporter Michael Hiltzik, U of Chicago professor Harold Pollack, and CATO Institute healthcare guru/Halbig co-architect Michael Cannon. "Objective Politics" chimed in with the link to the infamous moment above, which pretty much tells you everything you need to know about the opposing points of view at play in the ACA debate.

There's nothing wrong with reminding people about this, but I'm pretty disappointed with both the author as well as PBS for treating this as if it's a "surprise" or something unexpected:

Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.

Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve. Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014.

Looking to avoid the pitfalls and confusion that surrounded the launch of Obamacare, California is gearing up to get 1.2 million people to renew their health policies for next year.

This caught my eye because the total QHP enrollment number for California was actually 1,405,102 as of 4/19.

Now, Peter Lee did state that 85% of that number had paid their first month's premium as of just a week later, by 4/27...and as it happens, 1.2 / 1.4 = 85.7%, so it's possible that this is what the "1.2 million" refers to.

For awhile there I was concerned that Oregon's uglier-by-the-minute legal/technical headaches had caused them to stop bothering with regular updates; fortunately, they seem to be back on track again, updating both QHP and Medicaid numbers:

Wow! The WA Health Benefit Exchange, which hasn't issued an actual enrollment update since the end of the Open Enrollment period, just came through in a big way:

OLYMPIA, Wash. – Washington Healthplanfinder today announced 11,497 Washingtonians have taken advantage of special enrollment periods since March 31 that allow them to enroll through wahealthplanfinder.org if they have a qualifying life event outside of the standard open enrollment period. The next open enrollment period starts on Nov. 15, 2014 for coverage beginning in 2015.

Data also shows that nearly 700,000 residents are now enrolled in new free or low-cost health coverage options, with more than 147,000 customers currently enrolled in Qualified Health Plans. Including customers who are renewing their existing Medicaid coverage, more than 1.28 million residents have enrolled in health coverage through wahealthplanfinder.org.

Yeah, yeah, I know; a test server for Healthcare.Gov was successfully hacked into recently; no sensitive data was stolen, but Security was Breached, etc etc etc.

No, I'm not shrugging the incident off. I'm the one who called Hawaii's state exchange website out for taking over a week to resolve their own Heartbleed SSL vulnerability last spring. Yes, security is very important, especially with personal financial, medical and citizenship data. Hopefully the HHS techies are eliminating vulnerabilities, beefing up security and so forth.

I'm swamped with my day job at the moment, so I don't have a whole lot to add to the discussion at the moment...

North Carolinians could have three insurance carriers to choose from when enrollment under the Affordable Care Act reopens in November.

The state Department of Insurance has approved individual plans from UnitedHealthcare for the online marketplace, but they still need to be approved by the U.S. Department of Health and Human Services because the federal government operates the exchange.

Our state leaders may be moving slow on health care, but local leaders are giving them a nudge in the right direction.

Leaders of six of the state's largest counties -- ranging from Harris County's Republican Judge Emmett to Dallas County's Democratic Judge Jenkins -- have joined together to call on the legislature to find a "uniquely Texas solution" to covering uninsured low-wage workers.

The county leaders wrote to the legislature as the Senate Health and Human Services Committee met to discuss Texas alternatives to Medicaid expansion.

I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

Alabama, Alaska, Arizona and Arkansas are all relatively low-population.

California, Colorado, Connecticut and Delaware* are all state-run exchanges.

That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

So, the big news this morning is that the Kaiser Family Foundation has determined that the "benchmark silver plan" premiums in 16 major U.S. cities are expected to drop by 0.8% on average next year. Not a huge number, but the fact that they're dropping at all is astonishing given the "OMG!!! DOUBLE-DIGIT RATE HIKES!!" freakout which have dominated the most recent ACA critical attacks.

Of course, as has already been shown repeatedly, 1) premiums were already going up by 10-11% per year prior to the ACA exchanges launching anyway, and 2) many states have already reported in on their 2015 rates, and for the most part they're going up by...well, not much (and in some cases actually dropping):

Just two weeks ago, Sen. Mark Pryor (D-Ark.) surprised much of the political world with a powerful television ad. Though the conventional wisdom was that Pryor, facing a tough re-election fight, would avoid talking about the Affordable Care Act, but the senator neverthelessdid the opposite, boasting about the benefits he’s delivered for Arkansans through the ACA.

...Would Pryor back down? As it turns out, no. MaddowBlog received an exclusive first look at the Pryor campaign’s new campaign ad, which is the second spot in which the Arkansas senator boasts about ACA benefits.

BLAM! The infamous "$700B cut from Medicare!!" lie has been festering since well before the 2012 presidential election. The $700 billion in question refers to savings from cutting waste, fraud and abuse from the Medicare system (this is a good thing, folks).

...as I noted last week, there's a huge difference between what the insurance companies are asking for and what they actually get approved. As noted in the article CNY article:

Last year, insurers requested 9.5 percent increases in premiums for their individual plans, but the state Department of Financial Services, which regulates insurers, approved, on average, only a 4.5 percent increase.

In July, two Republican judges on the United States Court of Appeals for the District of Columbia Circuit handed down a decision defunding much of the Affordable Care Act (ACA). This effort to implement Sen. Ted Cruz’s (R-TX) top policy priority from the bench was withdrawn on Thursday by the DC Circuit, and the case will be reheard by the full court — a panel that will most likely include 13 judges. In practical terms, this means that July’s judgment cutting off subsidies to consumers who buy insurance plans in federally-operated health exchanges is no more. It has ceased to be. It is, in fact, an ex-judgment.

(Bonus points to Millhiser for the Monty Python nod.)

OK, so this means that the case will simply get bumped up to the SCOTUS, right? Well, not necessarily:

If it seems like I keep posting Minnesota's latest every few days, that's because...well, frankly, I am, for two reasons: First, they're updating it every few days (almost odometer-like); and second, MNsure is pretty much the only one posting updates on a regular basis (again, Oregon is now the only one doing so more frequently than once a month).

On the up side, those MN numbers keep increasing at a pretty impressive rate, with another 294 QHPs added and 5,848 more added to Medicaid/CHIP in just the past 6 days:

In a historical aberration, out-of-pocket spending on health care is expected to decrease in 2014, according to a new report from the Centers for Medicare and Medicaid Services, because of expanded insurance coverage under Obamacare.

CMS actuaries, writing in Health Affairs, projected that Americans' out-of-pocket spending would decrease by 0.2 percent. While that's a small drop, it's a big change from the historical trend of steadily increasing out-of-pocket spending. Out-of-pocket spending increased by 3.2 percent in 2013. According to the Kaiser Family Foundation's Larry Levitt, such spending has only decreased in 1967 (Medicare and Medicaid took effect) and in 1994 and 2009 under slowing economies.

I signed up for Anthem Blue Cross to meet the May deadline. My previous employer also was Anthem Blue Cross, with prescription drug benefits. As I am starting a new business, I chose to go with Covered California through Anthem Blue Cross. The same company, without the drug coverage — or so I thought. Here's what I got:

Cost $845 a month, $5,000 deductible.

Family physician doesn't take the plan.

Wife's gynecologist doesn't take the plan.

Dermatologist doesn't take the plan.

Dentist doesn't take the Covered California dental plan.

So for $10,140 in annual premiums and $5,000 deductible, I am now searching for new doctors for my family.

This Just In...3 out of the 5 insurers operating on the New Mexico ACA exchange are dropping their 2015 premium rates. A fourth is increasing theirs, and the fifth one is new. The overall average is a 1-2% drop, although I can't tell whether that's a weighted or unweighted average (neither the enrollee breakdown nor the actual % change for the individual companies is included in the article):

Individual health insurance premiums in New Mexico will drop by an average of 1 to 2 percent in 2015 for those who buy on the state’s health insurance exchange, New Mexico Superintendent of Insurance John Franchini said Wednesday.

Franchini’s office released the new individual rates from the five insurers that will be selling on the exchange. Three of those insurers – New Mexico Health Connections, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico – saw some decreases in their overall rates from this year, said Aaron Ezekiel, head of Affordable Care Implementation for the Office of the Superintendent of Insurance.

Presbyterian Health Plan had some increases, Ezekiel said. CHRISTUS Health Plan is new to the exchange.

As of midnight on Tuesday, all 7,700 CVS locations nationwide will no longer sell tobacco products, fulfilling a pledge the company made in February, as it seeks to reposition itself as a health care destination.

The rebranding even comes with a new name: CVS Health.

The decision to stop selling cigarettes is a strategic move as pharmacies across the country jockey for a piece of the growing health care industry. Rebranding itself as a company focused on health could prove lucrative for the drugstore as it seeks to appeal to medical partners that can help it bridge the gap between customers and their doctors.

The New York Times has an story this morning about the challenges facing the ACA exchanges as they head into Year Two of Open Enrollment. For the most part it's pretty good, but there's one bit of flawed reasoning which caught my eye. I was planning on writing an extensive response, but Xpostfactoid (whom anyone who visits this site regularly should also be reading) beat me to the punch:

No one can or will try to ensure eight million renewals, because a very large proportion of 2014's enrollees -- perhaps half or more -- will not need to renew their coverage. They will be covered by new employers, or new spouses, or newly employed old spouses, or they will lose income and become eligible for Medicaid, or they will go on disability, or die, or, or, or...

Read his whole piece. I'm only posting anything here in the hopes of gaining some exposure for his analysis.

(sigh) Here we go again. Over at Forbes, Avik Roy has decided that his contribution to celebrating the labor movement should be to trash the Affordable Care Act again, even though it's based primarily on his old boss's policy in Massachusetts.

There are some areas of his latest which I'm not equipped to address, but there are two points which jump out at me:

First, he brings up 2 surveys from the Federal Reserve Bank of New York about how business owners feel about the impact of the ACA on their expenses and employment.

I should first note that Roy refuses to refer to the healthcare law by anything close to its actual name. He doesn't call it the "Patient Protection & Affordable Care Act". He doesn't call it "the Affordable Care Act". He doesn't even call it "the ACA", which would make the most sense...not even once.

Nope, he refers to it as "Obamacare". Not just in the headline, not just once or twice in the article, but twenty-five times. I counted.

Now, I don't happen to have a problem with the "Obamacare" moniker. I think in the long run the GOP will regret tying the law to Barack Obama's name so closely. But THEY think it's an insult, and keep throwing it around as often as possible.

Thanks to the Kaiser Family Foundation's Larry Levitt, who linked to a PDF from the Florida Health Insurance Advisory Board. This report has data which has made the news twice already: First, because of the 13.2% "weighted average" premium increase for the state (which has come under fire for "weighting" based on projected membership instead of current membership), and secondly because of the exchange QHP enrollment number in June, which is 22.5% lower than the 4/19 total (but which, as I've already shown, isn't nearly as bad as right-wing outlets like the Daily Caller are claiming).

Levitt has noted a third interesting data point in this report:

Two-thirds of those buying their own insurance in Florida are now in ACA-compliant plans. http://t.co/JYVo1UXkvf

At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA.

This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism.

...Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan...AFP Michigan opposed the plan from the get-go.

...So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.

Several great ACA-related stories were written over the holiday weekend. First up is the NY Times' Austin Frakt, who looks into what sort of impact the addition of more companies onto the ACA exchanges is having on insurance premiums. Spoiler: More competition = lower prices (or at least less of an increase):

As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce?

...recent analysis by the Urban Institute found higher premiums in less competitive markets.

The good news is that markets will be more competitive in many exchangesin 2015, as more insurers offer plans. UnitedHealthcare has announced it will enter as many as 24 markets, for example.